I am Forbes' Opinion Editor. I am a Senior Fellow at the Manhattan Institute for Policy Research, and the author of How Medicaid Fails the Poor (Encounter, 2013). In 2012, I served as a health care policy advisor to Mitt Romney. To contact me, click here. To receive a weekly e-mail digest of articles from The Apothecary, sign up here, or you can subscribe to The Apothecary’s RSS feed or my Twitter feed. In addition to my Forbes blog, I write on health care, fiscal matters, finance, and other policy issues for National Review. My work has also appeared in National Affairs, USA Today, The Atlantic, and other publications. I've appeared on television, including on MSNBC, CNBC, HBO, Fox News, and Fox Business. For an archive of my writing prior to February 2011, please visit avikroy.net. Professionally, I'm the founder of Roy Healthcare Research, an investment and policy research firm. In this role, I serve as a paid advisor to health care investors and industry stakeholders. Previously, I worked as an analyst and portfolio manager at J.P. Morgan, Bain Capital, and other firms.

In South Carolina, Santorum Made the Case against Romneycare

Well, we’re finally getting somewhere in the Republican Presidential race. The field has been winnowed. Though I would have preferred a different final four, the smaller group allows for more detailed exploration of the issues, something that’s particularly important with health care. And the January 19 debate in Charleston, South Carolina provided the best discussion yet of the candidates’ views on health policy. Many opportunities were seized, but a few big ones were missed.

On that score, it was once again Rick Santorum who made the substantive case against Romneycare—a case that Mitt Romney’s other rivals have been incapable of making. Said Santorum, “The problem is that [Mitt Romney and Newt Gingrich] would be very difficult to elect on, I think, the most important issue that this country is dealing with right now, which is the robbing of our freedom because of Obamacare.”

In my view, this is exactly right: whatever anybody else says, the conservative case against Romney is Romneycare. There’s a reason that the Right rallied (too late) to Romney in 2008, when he was the conservative alternative to John McCain. Conservative bellwether National Review endorsed Romney in 2008, even though the magazine noted at the time that “not every feature of the health-care plan [Romney] enacted in Massachusetts should be replicated nationally,” but also that Romney can “speak with more authority than any of the other Republican candidates about this pressing issue.”

Today, many grassroots conservatives with short memories resent National Review for its 2008 endorsement, which they see as proof of the magazine’s supposed liberal establishmentarianism. (These activists never have to say who they would have instead supported.) The point is that the reason why conservatives supported Romney in 2008, and do so less now, is not because Romney changed, but because Obamacare became law.

Santorum describes Romneycare’s policy failures

And the truth is, of the 2012 GOP Final Four, only one candidate—Rick Santorum—has any credibility to go after Mitt Romney on the issue of health care policy. Santorum did it last week in Charleston, when he ripped Romneycare as an “abject failure” that Romney has “stood by.”

He’s stood by the fact that it’s $8 billion more expensive than under the current law. He’s stood by the fact that Massachusetts has the highest health insurance premiums of any state in the country; it is 27 percent more expensive than the average state in the country. Doctors—if you’re in the Massachusetts health care system, over 50 percent of the doctors now are not seeing new patients—primary care doctors are not seeing new patients. Those who do get to see a patient are waiting 44 days, on average, for the care.

It is an abject disaster.

He’s standing by it, and he’s going to have to have to run against a president — he’s going to have to run against a president who’s going to say, well, look, look at what you did for Massachusetts, and you’re the one criticizing me for what I’ve done? I used your model for it.

In response, Romney gave his usual defense of his Massachusetts legacy: that Romneycare was “not a government-run system” because “nothing changed” for the 92 percent of people who already had insurance; that those who were uninsured bought private insurance; that Bay State voters “still favor the plan three to one,” and that Obamacare raised taxes and cut Medicare.

There are responses to each of these points, and Santorum hit them all: (1) Romneycare’s treatment of the uninsured, as with Obamacare, involved expanding Medicaid and government subsidies and mandates for private insurance; (2) Massachusetts has had to raise taxes and enact price controls to deal with Romneycare’s cost spike; (3) Much of the cost of Romneycare was borne by taxpayers in other states, via the federal government.

Romneycare’s dramatic reduction in individual-market premiums

Romney made some other interesting points in his defense of Romneycare, namely that Massachusetts’ insurance costs were highest in the nation before Romneycare, and that “individuals who wanted to buy their own insurance saw their rates…drop by some 40 percent with our plan.”

I’ve done some research into these issues. Romney has a fair point regarding the fact that Massachusetts had high costs to begin with, but his law made these problems worse. He correctly claims that “the rate of growth has slowed down” relative to the country, but that is due to his successor’s imposition of price controls on insurers and hospitals.

He has, it turns out, identified one significant policy success for Romneycare. Between 2006 and 2009, according to data from AHIP, the insurer trade group, premiums for people buying health insurance for themselves went from $8,537 per year–by far the highest in the country–to $5,143, an astounding decrease of 40 percent. Over the same period, the national average went from $2,613 to $2,985, an increase of 14 percent. Family premiums in the individual market went down 21 percent in Massachusetts over the same period, whereas they increased by 9 percent nationally.

So that’s good news, but it is more than offset by all of the other things that Romneycare made worse.

Gingrich supported the individual mandate

Why is it that, of the entire GOP field, only Rick Santorum has described, on a policy level, why Romneycare drove overall health costs and waiting times skyward? A big part of it, sadly, is that most of Romney’s rivals don’t know a whole lot about health policy.

Another reason why Romneycare has gotten off easy in the debates is that one of the few candidates with health policy knowledge is Newt Gingrich, whose apostasies exceed Romney’s. In 2006 described Romneycare as an “exciting” plan with “tremendous potential.” And, as Santorum pointed out in the debate, Gingrich remains an advocate of the individual mandate, the most controversial aspect of Obamneycare:

And then we have Speaker Gingrich, who has been for an individual mandate, not back in the time [when] Heritage was floating [it] around in the Nineties, but as late as 2008. Just a few years ago, he stood up and said that we should have an individual mandate or post a $150,000 bond. How many $150,000 bondholders do we have here who can post a bond for their health insurance?

Just so. Though Santorum should have pointed out that Gingrich has advocated this mandate-or-bond idea, which is far worse than Obamacare’s mandate, not just in 2008, but as recently as May 2011. Santorum pointed out the lameness and dishonesty of Gingrich’s defense that he merely supported a mandate because he was “leading the charge against Hillarycare,” but now has “figured it out” that a mandate is wrong.

“Newt, you held that position for over 10 years,” said Santorum. “And, you know, it’s not going to be the most attractive thing to go out there and say, you know, it took me 10 or 12 years to figure out I was wrong, when guys like Rick Santorum knew it was wrong from the beginning.”

What will happen at tonight’s debate?

Tonight, in Tampa, Florida, there is yet another GOP debate. It will be interesting to see if Newt Gingrich’s checkered health-care track record becomes part of the conversation. It will be especially important for Santorum to take on Gingrich, given that Gingrich and Santorum are directly competing for the “not-Romney” vote. We’ll know more in a few hours.

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What is with the accuracy of Forbes. First the crazy statistics in the “The Success of RomneyCare…” Now this so called research from a New York elite who says:

“He (Romney) has, it turns out, identified one significant policy success for Romneycare. Between 2006 and 2009, according to data from AHIP…, premiums for people buying health insurance for themselves went from $8,537 per year–by far the highest in the country–to $5,143, an astounding decrease of 40 percent…”

Go back and check your research’s source documents and the state of Massachusetts web site. The AHIP clearly said in the documents from which you are quoting: 1. Not to draw any conclusions based on any of the state by state data because of AHIP’s methodology and 2. Not to draw any conclusions particularly about the Massachusetts data because its market was in turmoil.

If you had done the thorough research you claim you would realize: 1. This market only involved 46,000 people out of 6,500,000 of us in Massachusetts (only 26,000 policies) 2. The percentage decreases you cite related not to RomneyCare but to a legislative item called the “merged market” which happened simulataneously with RomneyCare. The 26,000 people buying individually were allowed to buy at the small group (600,000 people) rate. So our individuals premiums went down 20% one time and the 600,000′s group’s rates went up 2%. Simple insurance math; nothing to do with RomneyCare.

Forbes accuracy is decrepti. Apparently Forbes is in the tank for Obama. Got your marching orders I guess